Provider Demographics
NPI:1992472351
Name:LC CHIROPRACTIC LLC
Entity type:Organization
Organization Name:LC CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:LAZARO
Authorized Official - Last Name:MACHADO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:753-233-0260
Mailing Address - Street 1:1128 SW 146TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6165
Mailing Address - Country:US
Mailing Address - Phone:815-735-7445
Mailing Address - Fax:
Practice Address - Street 1:12145 SHERIDAN ST.
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026
Practice Address - Country:US
Practice Address - Phone:754-233-0260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1255828950OtherNPI
IL1932730058OtherNPI